Healthcare Provider Details

I. General information

NPI: 1780403915
Provider Name (Legal Business Name): RAGNAR W SCOTT PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E EVERGREEN BLVD STE 217
VANCOUVER WA
98660-3264
US

IV. Provider business mailing address

400 E EVERGREEN BLVD STE 217
VANCOUVER WA
98660-3264
US

V. Phone/Fax

Practice location:
  • Phone: 509-596-1138
  • Fax: 971-308-7811
Mailing address:
  • Phone: 509-596-1138
  • Fax: 971-308-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAP61615356
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10034127
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number10034127
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: